What You Should Know About the House of Representatives' New "Medicare for All" Bill

Have you heard that more than 100 members of the Democratic-majority U.S. House of Representatives have signed onto a new version of a "Medicare for All" bill? Yes, that's right, this is the House's latest version of a bill to universalize Medicare coverage in the U.S. that dates all the way back to 2003 and has seen different variations since, including the one that Sen. Bernie Sanders (I-Vt.) introduced back in 2016. This bill would essentially end nearly all existing public and private health care plans but Medicare, fold nearly everyone into a beefed-up version of Medicare, and fulfill the roughly $30 trillion pricetag in part by enacting major new taxes on millionaires and billionaires.

What's especially interesting about this version, unveiled by Rep. Pramila Jayapal (D-Wash.), is that it goes further than any previous such bill, including coverage of long-term care, the costs of which can impoverish elders and drain their estates for their progeny. (Current Medicare barely covers long-term needs.) It also would cover dental, hearing, and vision and allow the government to bargain down drug prices with pharmaceutical companies -- also currently not allowed.

And yet another interesting thing about this bill is that it came right out of the gate with more than 100 House Democrats supporting. That's a far bigger start than any previous such bill has had, and it reflects the House's new progressive wing, which is setting up the Democratic Party for a massive center-versus-left soul-searching as we head into the 2020 election season. More broadly, of course, it reflects a progressive surge in American politics and the realization that Obamacare has not solved the American health care crisis.

But hold up! We can't overstate how far away from becoming reality the bill is. House Speaker Nancy Pelosi (D-Calif.) hasn't said if she supports it or would bring it for a vote. In fact, she just seemed to dismiss it wholesale, asking, "How do you pay for that?"

It would almost certainly fail in the Senate, still ruled by Republicans who equate single-payer, universal health care with evil, scary socialism. And even if it passed both chambers, Trump would almost certainly not sign it. The massive power of the health care and health insurance lobbies, which want to keep things the way they are or make worse coverage options legal, cannot be overstated.

In other words, the bill may reflect some version of the wishes of 70% of the electorate, according to a recent poll, but unless Democrats seize both chambers of Congress and the White House in 2020, and unless a popular groundswell continues pushing Democratic leadership to the left, it all remains wishful thinking.

We checked in with our favorite health care wonk and activist Mark Hannay, director of Metro New York Health Care for All Campaign, to chat more about what #M4All, as they call it on Twitter, means for folks with HIV -- and how it all might play out in the months and years ahead.

Tim Murphy: Hi, Mark! So what are your billboard thoughts about this bill?

Mark Hannay: Hi! Well, there's two aspects of it. One is the policy side. This is a significant improvement over the previous bill in the House. The biggest change is that it would cover long-term care. The current Medicare program only covers a couple months of hospitalization and recovery. Most people have to spend down their assets, or sign them over to others ahead of time, so they can then qualify for Medicaid and live on a very limited income. I think this aspect would be very popular among older voters or those with disabilities.

The other aspect is the political side. This bill was introduced with 107 sponsors. The previous bill worked its way up to 120 sponsors, but to have this many from the get-go is significant and reflects the new wave of progressives who've come into the House. Many of these folks ran in the 2018 midterm campaigns on the "Medicare for All" catchphrase. The whole idea has become much more prominent, has more public awareness, and is being taken much more seriously by policy advocacy groups on both sides. It's no longer dismissed as a left-wing fringe idea. It's part of the political mainstream, even if it's not at the exact center of the mainstream.

TM: But so much would have to happen for this to become reality, yes?

MH: First it would have to get through three House committees. Nancy Pelosi has said she will allow hearings on this sometime soon. But if we know one thing about Pelosi, it's that she doesn't take things to the floor unless the votes are ready to go, and so far less than half the Democratic majority in the House has signed on.

The current Senate is not going to take this up, and it's highly unlikely that Trump would sign it. It's an aspiration bill, a placeholder for something that has yet to go through the sausage-making process. When and if the hearings occur, then the bill can be aired out, to make sure everyone understands what's being talked about, then people could put forward amendments in a second round of hearings.

TM: So, say that both chambers of Congress and the White House go Democratic in 2020?

MH: Let's assume we get both chambers and the new president amenable to this. Passing Obamacare was a good 1.5-year process, so I think this would be a similar time-frame, starting in early 2021. Let's say it's enacted into law before the 2022 midterm elections. Then this version envisions a two-year phase-out of the current system and implementation of the new, with lots of details to be worked out in regulations and guidelines in several different government agencies. So we're looking at 2024-26 before the whole system would be in place.

TM: What would #M4All mean for people with HIV?

MH: The bill promises to retain only two other government coverage programs, the Veterans Health Administration and the Indian Health Service. That means that all other programs, including Medicaid and the HIV-specific ADAP [AIDS Drug Assistance Program], would be folded into #M4All, and most employer-based and private-market plans would be phased out, although people would be able to buy private insurance on top of #M4All if they wanted to.

I think overall, people with HIV should welcome and support this, because, in the end, they'll get much better coverage. That said, they, like other key constituencies, are going to have a lot of very legitimate questions they deserve to have answered.

TM: A lot of the 2020 presidential candidates are using the #M4All catchphrase, but it doesn't necessarily mean the same thing to all of them, right?

MH: Right. It could mean a version where you can buy into Medicare, but it's not required. Say for people 50 or over. Or where only people 50 or over are automatically enrolled. Still, I don't think there's any version that will actually be enacted absent a broader political movement in the U.S. that also includes a Green New Deal, campaign finance reform, expanded voting rights -- a bunch of things that are indicative of a progressive political transformation.

TM: What if a new wave of Democrats are elected in 2020 who won't necessarily get on board with #M4All, given the corporate pressure against it, and who haven't been held to a promise on it?

MH: I don't have a good answer to that. The interesting thing about this new class of Democrats in the House is that there's a bunch of progressives but also a bunch of centrists who come from previously Republican districts who are much less likely to be enthusiastic about #M4All. So for Pelosi, how does she bridge this and keep everyone together? It can turn into a circular firing squad where centrists and progressives turn on each other and the other side takes full advantage of that. Then we get nothing. This is a long game, so how do we get there? I do know that there has to be a vanguard that does not give up on the #M4All message.

TM: So what can readers and citizens do if they want to get behind the #M4All momentum?

This is a visionary bill, and we need to keep getting that vision out there and asking the candidates about that vision, because it'll help to frame the nitty-gritty that starts to happen down the road.

Tim Murphy has been living with HIV since 2000 and writing about HIV activism, science and treatment since 1994. He writes for POZ, New York Times, New York Magazine, Out Magazine, The Advocate, Details and many other publications.